2nd OR Case: Cheilectomy Exostectomy

As fancy as it sounds, it is actually commonly referred to as Bunionectomy. It is a surgical procedure performed to remove bone spurs from the base of the great big toe. With research, most RA patients have hallux rigidus, it is a condition wherein the joint wears away from the base of the big toe. Our patient today don’t have arthritis. Hers is genetic in nature, as per our surgeon, and is probably uncomfortable with her shoes more than anything else. So she needed it taken out.

As an OR Nurse, main duty is to make sure the Patient and OR Room is ready for the procedure. Lab results have to be at their acceptable levels and on the patient’s chart, so as with the consent and H&P. For the hospital I work at, Consents are good for 30 days, H&P will have to be current for 24 hours, if not, and addendum must be completed by the surgeon prior to procedure. Interviewing patient is also very important duty of the OR Nurse. Noting NPO, drug allergies, beta blocker intake, other medication intake, metal accessories/tattoos/prosthetics and/or hearing aids. Reassuring patient, calming them down prior to surgery, and making sure they understand the procedure is necessary, as well.

For OR preparation, I noticed that there are those equipments/settings and supplies common to every surgery. Equipments such as the Bovie Cautery Machine (with the electrosurgical grounding pad usually attached to patients outside thigh – away from bony prominence, tattoo or any body parts with metal) is mostly set to 30/30 – Cut and Coag – Blend. Circulation machine attached on both legs for blood circulation specially on long surgeries. Others are fixed OR equipments such as the OR table, video machines, arm rests and anesthesia machine.

Some equipments are specific to the procure. Today’s special machine is the Tourniquet Machine, this enabled to surgeon to work on a bloodless operative field preventing blood flow to the limb. This machine, as I was thoroughly informed, can only be used straight 120 minutes or less. Any procedure over 2 hours, you have to turn it off for at least 15 minutes before turning it back on.

As soon as patient came in to the OR room, we moved patient from stretcher to OR table. Strap her for support, covered with arms before strapping upper extremity with velcro. Also attached blood cuff for BP monitoring, Bovie machine and electrode, and circulation machine.

The medications I remembered from today’s procedure are Ancef IV Piggy Back, Normal Saline, warmed LR for irrigation, and 0.25 Marcaine/Bupivaciane (Sensorcaine) for local anesthetic. For skin prep, we used Hibiclens (pretty pink) and Chloraprep. Had Surgi Tech hand over extra towel for cleaning up.

Before cutting starts, Timeout is called by RN. Name and DOB verified, area, kind of procedure, medication taken was agreed upon. When everything check out, surgery starts. Surgical Tech is the one who assists the surgeon with equipments and Nurse become patient’s advocate.

Just before suturing starts, counting of supplies commences. Dr can leaves only when everything is accounted for. Waking patient from there anesthesia, cleaning up of patient starts, drapes comes of and transferring patient to stretcher from OR table happens at this phase. We then took patient to PACU for recovery.

This procedure took roughly 30 minutes. It was fast. And since these are few of the first cases of podiatric surgeries done in this facility, some supplies are not readily available. But surgeon was cool. And we all like that!

About The Author

I am an Igorota now based in California. I was born and raised in a valley nestled between the pine-forest zones of Cordillera. I am proud of my unique culture and pristine traditions. My ethnicity differentiates me from others, it defines me in a way that no other words can. I take pride in my ancestors' heritage passed from one generation to another. I embrace the rich history that makes up my individuality and respect the land that cradles the place I forever will call home...